Radiofrequency Thermotherapy for Treating Axillary Hyperhidrosis.

BACKGROUND: Thermotherapy has been established between conservative and surgical options as a minimally invasive method for the treatment of axillary hyperhidrosis. OBJECTIVE: The objective of this study was to present radiofrequency thermotherapy (RFTT) as a safe and effective new treatment method. MATERIALS AND METHODS: Thirty adult patients with pronounced axillary hyperhidrosis were treated with RFTT with noninsulated microneedles 3 times at intervals of 6 weeks. Subjective improvement was rated using the Hyperhidrosis Disease Severity Scale (HDSS) and Dermatology Life Quality Index (DLQI). Satisfaction and estimated reduction of sweating were monitored. Objective measurements were made using gravimetry. Adverse effects were recorded in follow-up. At the 6-month follow-up, improvement in sweating was seen in 27 patients. The HDSS dropped from 3.4 to 2.1, the DLQI improved significantly from 16 to 7. The gravimetric measurements of sweat were reduced from 221 to 33 mg/min. The average reduction of sweating was reported to be 72%. Adverse effects were generally mild and improved rapidly. CONCLUSION: Radiofrequency thermotherapy was shown to be an effective and minimally invasive treatment option for axillary hyperhidrosis. Patients described their sweating as normal. The method clearly has the potential to normalize axillary sweating.

Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding.

INTRODUCTION: Prothrombin complex concentrates are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of prothrombin complex concentrates in the surgical setting. METHODS: The case notes of 50 patients requiring urgent oral anticoagulation reversal (n = 12) or with severe perioperative coagulopathic bleeding (n = 38) who received an infusion of prothrombin complex concentrate (Beriplex P/N(R) 500) at the surgical department of the University of Munich Hospital, Germany were retrospectively reviewed. Efficacy of prothrombin complex concentrate application was evaluated using the Quick test, reported as an international normalized ratio, hemodynamic measurements and requirement for blood products. Safety assessments included whole blood hemoglobin levels and specific parameters of organ dysfunction. RESULTS: Baseline characteristics were comparable, except that mean baseline international normalized ratio and hemoglobin levels were significantly higher (P < 0.01) in anticoagulation reversal than in bleeding patients. In anticoagulation reversal, the international normalized ratio was significantly reduced (from 2.8 +/- 0.2 at baseline to 1.5 +/- 0.1, P < 0.001) after one prothrombin complex concentrate infusion (median dose 1500 IU; lower quartile 1,000, upper quartile 2,000). No major bleeding was observed during surgery after prothrombin complex concentrate administration. Only one patient received platelets and red blood cell transfusion after prothrombin complex concentrate administration. In bleeding patients, infusion of prothrombin complex concentrate (median dose 2,000 IU; lower quartile 2,000, upper quartile 3,000) significantly reduced the INR from 1.7 +/- 0.1 at baseline to 1.4 +/- 0.1 (P < 0.001). This decrease was unrelated to fresh frozen plasma or vitamin K administration. Bleeding stopped after prothrombin complex concentrate administration in 4/11 (36%) patients with surgical bleeding and 26/27 (96%) patients with diffuse bleeding. Hemoglobin levels increased significantly from baseline in bleeding patients (P < 0.05) and mean arterial pressure stabilized (P < 0.05). No thrombotic events or changes in organ function were reported in any patient. CONCLUSIONS: Prothrombin complex concentrate application effectively reduced international normalized ratios in anticoagulation reversal, allowing surgical procedures and interventions without major bleeding. In bleeding patients, the improvement in coagulation after prothrombin complex concentrate administration was judged to be clinically significant.

A critical analysis of laparoscopic appendectomy: how experience with 1,400 appendectomies allowed innovative treatment to become standard in a university hospital.

BACKGROUND: Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis. METHODS: Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded. RESULTS: After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 +/- 2 min. Between 1995 and 2005 about 25%-30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 +/- 0.1 days versus 6.6 +/- 0.2 in open appendectomy; p < 0.001). CONCLUSIONS: This analysis provides evidence that LA can be introduced in an university hospital with acceptable results despite low operation numbers per surgeon and a liberal teaching policy. The LA procedure, which is associated with a 2%-4% rate of reoperation, may serve as laparoscopy training for young surgeons.